Clinical Outcomes Following Suturing of Sheath of Peroneal Tendons to the Calcaneal Plate as an Innovative Technique for Reduction of Peroneal Tendon Instability Accompanying Calcaneal Fracture

Abstract

Background The aim of the study was to evaluate the clinical and functional outcomes following suturing of sheath of peroneal tendons to the calcaneal plate as an innovative technique for reduction of peroneal tendon instability (PTI) accompanying calcaneal fracture surgically treated via extensile lateral approach (ELA). Methods In a retrospective comparative study, among 245 operatively treated calcaneal fractures through ELA, we had 33 cases with PTI who underwent relocation of the peroneal tendons with ethibond suture in a figure-of-8 shape, passed through 2 parts of sheath of peroneal tendons and stitched to the calcaneal plate. Of the 33 cases, 12 were evaluated in the experimental group. Twelve surgically treated calcaneal fractures without PTI were matched as the control group. The outcome of the patients was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot Function Index (FFI) percentage, Visual Analog Scale (VAS) pain, changes in Tegner activity level, maximal peroneal muscles strength testing, modified Star Excursion Balance Test (mSEBT), and triple hop for distance (THD) test. For the last 3 tests, the difference between operated and normal feet was calculated for each patient and this difference was compared between the 2 groups. Results There was no statistically significant difference between the 2 groups for AOFAS Ankle-Hindfoot Scale (P = .09), FFI percentage (P = .12), VAS pain (P = .73), changes in Tegner activity level (P = .87), maximal peroneal muscles strength testing (P = .45), mSEBT (P > .05), and THD (P = .87) tests. We had a case with point tenderness on retromalleolar groove and 4 cases with paresthesia in the territory of the sural nerve in the experimental group in contrary to one case of sural nerve paresthesia in the control group (P = .31). Conclusions Relocation of peroneal tendons in PTI accompanying calcaneal fractures by fixing sheath of peroneal tendons to the calcaneal plate could be an acceptable procedure with good outcomes but may have increased chance of sural nerve injury. Levels of Evidence: Therapeutic, Level III: Retrospective